MEDICATION RECONCILIATION

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MEDICATION RECONCILIATION

• Jo-Anne Thompson RN
• Patient Safety Officer
• South Eastman Health

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WHO ARE WE?
There are 11 regional health authorities in
Manitoba.
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SOUTH EASTMAN RHA
population 66,984 (6 of MB)
Source Manitoba Health (June 2009)
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PERSONAL CARE HOME BEDS
N 334
St. Adolphe 42
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SOUTH EASTMANS MED. REC. STEERING COMMITTEE

• Jo-Anne Thompson (Chair) - Patient Safety Officer
• Jan Gunness (Executive Sponsor) - Manager of
  Quality Corporate Planning
• Cecile Dumesnil- Regional Director of Pharmacy
• Lothar Dueck Pharmacist
• Dr. S. Migally Physician
• Brenda Barkman Clinical Resource Nurse (CRN)
  Rehab Unit
• Donna Bella Home Care Case Coordinator
• Charleen Barkman Staff Development
  Coordinator-LTC
• Shirley Bezditny Staff Development Coordinator-
  Acute Care
• Tannis Nickel-Director of Nursing (DON) Rest
  Haven Nursing Home
• Public Health, Mental Health (Reps needed)

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WHAT ARE WE TRYING TO ACCOMPLISH?

• Develop and implement a regional Medication
• Reconciliation process throughout the continuum
  of care, which will help prevent medication
  errors from occurring and reduce the potential
  for harm to patients.
• It has started in Acute Care (Phase I) and will
  continue to spread to all other areas of service
  i.e.) Long Term Care, Home Care, Community etc
• Phase II commenced Spring 2009.
• Pilot site Rest Haven Nursing Home.

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HOW WILL WE DO THIS?

• PDSA ( Plan-Do-Study-Act) Improvement Model
• PLAN Creating forms that work within South
  Eastman Health
• DO Testing the forms on the pilot sites
• - Rest Haven Nursing Home (LTC)
• STUDY Evaluating and modifying the forms.
• ACT Implementing changes on the forms and
  planning for the next cycle.

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HOW WILL WE KNOW WE ARE MAKING A DIFFERENCE ?

• The team is currently performing baseline chart
  audits in order to measure our successes.
• Discrepancies between the home medications and
  the admission orders are measured.
• The goal of the Med.Rec. project is to reduce
  these discrepancies over time. Ongoing testing
  will occur at various points of the project to
  assess the impact of the Med.Rec. process.

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WHAT ARE WE MEASURING?

• No discrepancies
• Intentional discrepancies Physician has made an
  intentional choice to add, change or discontinue
  a medication and is clearly documented.
• Undocumented Intentional Discrepancy Physician
  has made an intentional choice to add, change or
  discontinue a medication but this choice is not
  clearly documented. i.e) Nitro-patch put on hold
  or discontinued but no reason given. This
  captures the accuracy in documentation
• Unintentional Discrepancy Physician
  unintentionally changed, added or omitted a
  medication the patient was taking prior to
  admission. This reflects the errors that
  inadvertently occur when writing orders.
• The primary goal is to eliminate the undocumented
  intentional and unintentional discrepancies
  through the medication reconciliation process.

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GOAL

• The area of focus will be to decrease the mean
  of undocumented intentional discrepancies on
  patients admitted to the hospital LTC
  facilities by 75, as well as the unintentional
  discrepancies by 75.

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SO HOW DO WE KNOW THAT WE ARE SUCCEEDING?

• To know that we are succeeding in LTC the
  undocumented unintentional discrepancies will
  need to meet the set goal line over 6 consecutive
  months to master this process.
• LTC is tracking the percentage of residents
  reconciled at admission which coincides with
  Accreditation Canada standards which is 100.

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What Does the Audit results reveal for our 4
sites.
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POSITIVE GAINS WITH THE PROCESS

• Earlier identification of issues with patient
  home medications
• Developed a Medication Risk Assessment Tool used
  on admission that engages Pharmacists by referral
• Increased documentation of allergies
• Decreased duplication in recording medication
  histories
• (Both for Physician Nurse)
• Improved communication of medication histories to
  all disciplines
• Improved communication to next healthcare
  provider for changing or not ordering home
  medications

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CHALLENGES

• As we progress in spread challenges may present
  it self. The steering committee team will work on
  resolving issues on a ongoing basis.
• Continuous Education for all new employees hired

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SOUTH EASTMAN HEALTH

• Team work involves the Patient/Client/Families,
  Nurses, Physicians and Pharmacists
• Working as a team in South Eastman Health we can
  make a difference by improving patient safety and
  reducing potential adverse outcomes of care
  related to medications

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REFERENCES

• Canadian Patient Safety Institute
• Manitoba Institute for Patient Safety
• Safer Healthcare NOW!

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